Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis
Evaluation of plaque characteristics in acute coronary syndromes: non-invasive assessment with multi-slice computed tomography and invasive evaluation with intravascular ultrasound radiofrequency data analysis
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DOI：
10.1093/eurheartj/ehn356
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发表时间：
2008-10-01
影响因子：
39.3
通讯作者：
Bax, Jeroen J.
中科院分区：
文献类型：
--
作者：
Pundziute, Gabija;Schuijf, Joanne D.;Bax, Jeroen J.
目的动脉粥样硬化斑块特征在冠状动脉事件的发生中起重要作用。我们研究了急性冠状动脉综合征（ACS）和稳定性冠状动脉疾病（CAD）患者的多层螺旋CT（MSCT）和虚拟组织学血管内超声（VH IVUS）的冠状动脉斑块特征。方法和结果50例患者（25例ACS，25例稳定性CAD）接受了64层螺旋CT，48例（96%）患者接受了VH IVUS。在ACS患者中，32%的斑块在MSCT上为非钙化，59%为混合型[相应比值比（95%置信区间）分别为：3.9（1.6-9.5），P = 0.003和3.4（1.6-6.9），P = 0.001]。在稳定型CAD患者中，完全钙化病变更常见（61%）。在VH IVUS上，ACS患者斑块中的坏死核心百分比较高（11.16 +/- 6.07 vs.稳定性CAD中的9.08 +/- 4.62%，P = 0.02）。此外，薄帽纤维粥样硬化在ACS患者中更常见（32% vs. 3%，稳定性CAD患者，P = 0.001），最常见于MSCT上的混合斑块。结论ACS患者与稳定期CAD患者在MSCT上的斑块特征存在差异。ACS患者的斑块在VH IVUS上表现出易破裂的特征。多层螺旋CT可能有助于非侵入性识别与高风险相关的动脉粥样硬化斑块模式。
Aims Atherosclerotic plaque characteristics play an important role in the development of coronary events. We investigated coronary plaque characteristics on multi-slice computed tomography (MSCT) and virtual histology intravascular ultrasound (VH IVUS) in patients with acute coronary syndromes (ACS) and stable coronary artery disease (CAD).Methods and results Fifty patients (25 with ACS, 25 with stable CAD) underwent 64-slice MSCT followed by VH IVUS in 48 (96%) patients. In ACS patients, 32% of plaques were non-calcified on MSCT and 59% were mixed [corresponding odds ratio (95% confidence intervals): 3.9 (1.6-9.5), P = 0.003 and 3.4 (1.6-6.9), P = 0.001, respectively]. In patients with stable CAD, completely calcified lesions were more prevalent (61%). On VH IVUS, the percentage of necrotic core was higher in the plaques of ACS patients (11.16 +/- 6.07 vs. 9.08 +/- 4.62% in stable CAD, P = 0.02). In addition, thin cap fibroatheroma was more prevalent in ACS patients (32 vs. 3% in patients with stable CAD, P = 0.001) and was most frequently observed in mixed plaques on MSCT. Plaque composition both on MSCT and VH IVUS was identical between culprit and non-culprit vessels of ACS patients.Conclusion On MSCT, differences in plaque characterization were demonstrated between patients with ACS and stable CAD. Plaques of ACS patients showed features of vulnerability to rupture on VH IVUS. Potentially, MSCT may be useful for non-invasive identification of atherosclerotic plaque patterns associated with higher risk.